Annals of Psychophysiology Volume 3, October 2016 Advance Educational Institute & Research Centre ISSN

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1 Original Article Prevalence of Nosocomephobia Hospital Related Zehra Ashraf, Syeda Arooba Raza, Fizza Khalid, Zahra Sabzwari and Dur-re-Shahwar Faculty of Pharmacy, Jinnah University for women, Karachi, Pakistan Corresponding Author: Abstract Aim of research Study: The aim of study was to assess hospital phobia and its variation of depressive symptoms in primary care population. Introduction: Nosocomephobia is the fear of hospitals. It is a fairly common phobia; many people are known to suffer from it. Like that If I go to a hospital, I m fairly sure it is a fact that my life is not guaranteed. Patients are afraid of hospitals, especially the emergency rooms. Hospitals are the mark of cure and health. They even usually result in huge expenses. Most people understand that it is a medical necessity and that one does not and fear must be overcome in case of Nosocomephobia though, the patient simply refuses to go to a hospital and the result often are not desirable including death especially in case of major life threatening conditions. Result: In Primary Care population (PCP) severity of Hospital-phobia is very high. Patients show different depressive symptoms like nausea, loss of appetite, mood swing etc. The result of survey shows that insomnia is the highest number found in depressive patients which is approximately 50% in male patients alone. Female the percentage is slightly low i.e. approximately 40%. Discussion and Conclusion: A survey has been conducted at Karachi to ascertain how many people are suffering from hospital phobia. Our survey result showed that the hospital fear (nosocomephobia) is very common in the biggest city of Pakistan i.e. Karachi. The best way to overcome the nosocomephobia is to change the mindset of the patient through some self-help techniques. Keywords, Hospital, Phobia, Phobic disorders, Patient care population Introduction The research into the problem of phobic disorders is very extensive. (Beidel, D.C. and Turner, S.M., 2007). A fear of hospitals and doctors is commonly found in the community but is not bounded. When such a fear is become irrational and sufficiently severe situation and health should be the just concerns may arise (Zigmond, A.S. and Snaith, R.P., 1983). There are fears in common people about hospitals. First of all, it is commonly understood that whenever doctor s advices patient for hospitalization it means the illness is very serious Marks, (I.M. and Gelder, M.G., 1966). Although it is not necessary but people think like that. The second fear of hospital is the expenses occurs this in. Unnecessary tests are advised which resulted in heavy financial burden as well as a painful process (Singh, T.K., Ahmad, A. and Chowdhury, A., 2014). Nosocomephobia is the fear of hospitals. It is a fairly common phobia; many people are known to suffer from it. Like that If I go to a hospital, I m fairly sure It is a fact that my life is not guaranteed. (Pellosmaa, H.B. and Desouky, T.F., 2013) Normally, patient found ways of dealing with a surge of emotions are associated with hospitals. Most people understand that it is a medical necessity and that one does not and fear must be overcome in case of Nosocomephobia though, the patient simply refuses to go to a hospital and the result often are not desirable including death especially in case of major life threatening conditions. (Peters, L., 2000) Symptoms of depression are visible in body, mood and thoughts and that affects the way a person eats, sleeps, self-concern by over thinking. (Hamilton, M.A.X., 1959) is not the same as a passing blue mood. Fear is not a sign of personal weakness. People with depression cannot merely pull themselves together and get better. (Liebowitz, M.R., 1987) Physicians are unable to detect emotional disorder because they are not confident enough in procedure of detection or patient may think that his complaint was not being taken seriously. The information about this order can be gathered by a Questionnaire which the patient may complete. (Zimmerman, M., McDermut, W. and Mattia, J.I., 2000). The questionnaire should be simple and should not include reference to abnormal perception. The patient s own views should be considered as he/she is the best judge of his/her state. By this questionnaire, it Zehra Ashraf 27

2 was considered that the methods usually adopted are prolonged and desired administration by a trained worker, or if short and designed, recognition is necessary for proper diagnostic of the patients then another questionnaire will be made which will distinguish between anxiety and depression and the information collected will be very much helpful and reliable for the patient to know about the disorder for which he was consulting. (Torgersen, S., 1983) Other than this order that is Psychiatric lexicon we have seen some various state of stress like Grief, loss of self-esteem and so on (Fava, M., Rankin 2000). A questionnaire includes all these states would be not much useful for physicians, so physicians focus on loss on pleasure response which is the obligatory state of depressive disorder and this is supposed to be that it is due to disturbance of neurotransmitter mechanism which can be improved by antidepressant medication. These depressive states reduce the ability to experience pleasure. (Malasi, T.H., Mirza, I.A. and El Islam, M.F., 1991) The goal of study was to assess hospital phobia and its variation of depressive symptoms in primary care population. Methodology Domain of study: The study of plat was Paris of Asia (Karachi) which is the sizeable and populous city of Pakistan. The 7 th largest and most populous urban agglomeration in the World. Karachi metro has an estimated population of over 23.5 million people as Purpose of study: The survey was conducted among 200 patients, it has been supervise to perceive about hospital phobia. For this purpose, a survey was sketch to conduct fresh enumeration from different parts of Karachi (Pakistan). It was disseminate among various divisions of society. The questionnaire was based on MCQ s asking the people to give their fair point of view about Nosocomephobia that is hospital phobia. Most of the people understand that it is a medical necessity and that one does not have a choice but to get over with it. The patient simply refuses to go to a hospital which results in some very negative. Some of the questions asked by us included: 1. Worrying thoughts go through my mind. 2. I get sudden feelings of panic 3. I can sit at ease and feel relaxed. 4. I feel rest less and have to be on the move. 5. Do you experience any of these symptoms? (Like Diarrhea, Insomnia, Abdominal Cramps, Nausea, Less Appetite) 6. What kind of treatment/tests makes you frightened? (Like I/V, I/M, Different tests, Many medicines, Drips) Result In Primary Care population (PCP) severity of Hospital-phobia is very high. Patients show different depressive symptoms like nausea, loss of appetite, mood swing etc. The survey shows that on nosocomphobia i.e. hospital related phobia provided us a consistent result as follows: Table 1 shows the depression scale which is further divided into three categories that are (1) normal having answer scale in range 0-7 (2) borderline depression having answer scale in range 8-10 and (3) depression having answer scale in range Table 2.1 and figure 2.1 representing the depression s symptoms regarding the aspect of males in which four symptoms are shown along with their respective percentages, these symptoms include diarrhea experienced by 16.88% males, insomnia by 40.25%, abdominal cramps by 18.16%, nausea by 22.60% and less appetite by 25.95% males respectively. Similarly, depression s symptoms are also seen in females, table 2.2 and figure 2.2 represents these symptoms along with their respective percentages, these symptoms includes diarrhea experienced by 21.94% females, insomnia by 39.83%, abdominal cramps by 23.57%, nausea by 16.26% and less appetite by 16.26% females respectively Reasons of depression being arise from admitting to hospital are also taken under consideration of this survey which are the sort of treatments which make people little worried, depression experienced by males from certain treatments is shown in table 3.1 and figure 3.1 which includes I/V by 33.76%, I/M by 24.67%, different tests by 40.25%, many medicines by 40.25% and drips by 32.46% respectively. Similarly, depression experienced by females with respect to treatment are discussed in table 3.2 and figure 3.2 respectively which includes I/V by 30.08%, I/M by 14.63%, different tests by 24.34%, many medicines by 20.32% and drips by 35.77% respectively. As the age is essential factor which plays a great role in any research or survey, the depression according to age is also considered and table 4.1 is and figure 4.1 are representing the depression scale along with respective ages with respect to males, the ranges of age under which the percent of depression lies are: (a) in which depression % is about 11.68% (b) in which depression % is about 9.09% (c) in which depression % is about (d) in Zehra Ashraf 28

3 which depression % is about respectively. Similarly, the ranges with respect to females are: (a) in which depression % is about 14.28% (b) in which depression % is about 7.79% (c) in which depression % is about 5.19% (d) in which depression % is about 11.6% respectively. Table 5.1 and figure 5.1 represents borderline depression related to hospital with respect to males which comprises of age range along with percentages of borderline depression, these are: (a) in which depression % is about 14.28% (b) in which depression % is about 7.79% (c) in which depression % is about 5.19% (d) in which depression % is about 11.6% respectively. Similarly, table 5.2 and figure 5.2 represents borderline depression related to hospital with respect to females which comprises of age range along with percentages of borderline depression, these are: (a) in which depression % is about 17.88% (b) in which depression % is about 8.94% (c) in which depression % is about 4.87% (d) in which depression % is about 2.43% respectively. Normal people without any sort of depression are also taken under consideration, the table 6.1 and figure 6.1 showing the % of normal males according to age range which are as follows: (a) in which normal % is about 18.18% (b) in which normal % is about 7.79% (c) in which normal % is about (d) in which normal % is about respectively. Similarly, the table 6.2 and figure 6.2 showing the % of normal females according to age range which are as follows: (a) in which normal % is about 32.52% (b) in which normal % is about 4.87% (c) in which normal % is about 4.06% (d) in which normal % is about 1.62% respectively. Answer Scale Normal Borderline Figure # 2.1: Hospital s Symptoms appears in Male Symptoms 16.88% 40.25% 18.16% 22.60% 25.95% Diarrhea Insomnia Abdominal Cramps Nausea Less Apetite Figure # 2.1: Hospital s Symptoms appear in Male 39.83% Symptoms 21.94% 23.57% 16.26% 16.26% Diarrhea Insomnia Abdominal Cramps Nausea Less Apetite Figure # 2.2: Hospital s Symptoms appear in Female Zehra Ashraf 29

4 Treatments 33.76% 24.67% 40.25% 40.25% 32.46% I/V I/M Different Tests Many Medicines Drips Figure # 3.1: Reasons of from Admitted to Hospital (Male) 30.08% 14.63% Treatments 24.34% 20.32% 35.77% I/V I/M Different Tests Many Medicines Drips Figure # 3.2: Reasons of from Admitted to Hospital (Female) 9.09% 11.68% Figure # 4.1: Hospital in Male 3.25% 6.50% 3.25% 8.94% Figure # 4.2: Hospital in Female Zehra Ashraf 30

5 Borderline depression 11.60% 5.19% 7.76% 14.28% Figure # 5.1: Hospital s Borderline in Male 2.43% Borderline depression 8.94% 4.87% 17.88% Figure # 5.2: Hospital s Borderline in Female Normal male 7.79% 18.18% Figure # 6.1: Normal Male among Survey People 32.52% Normal female 4.87% 4.06% 1.62% Age range Figure # 6.2: Normal Female among Survey People Zehra Ashraf 31

6 Discussion & conclusion A survey has been conducted at Karachi to ascertain how many people are suffering from hospital phobia. Our survey result showed that the hospital fear (nosocomephobia) is very common in the biggest city of Pakistan i.e. Karachi. Many people are frightened to enter the hospital buildings, some of them are scared of blood, germs, surgical procedures, some patients feel nervousness about the procedures because they can cause pain in the body. (Starcevic, V. and Bogojevic, G., 1997) Nosocomephobia causes different depressive symptoms like heart palpitations, dizziness, insomnia, diarrhea etc. (Robertson, J.G., 2003). Result of survey shows that insomnia is the highest number found in depressive patients which is 40.2% in male whereas in female it is slightly low i.e. 39.8% The best way to overcome the nosocomephobia is to change the mindset of the patient through some self-help techniques. If you are in phobia never go to hospital alone take some friends with you. In hospital s waiting area read your favorite books or talk with your friends otherwise go to hospital café and enjoy tea/coffee to relax your mind (Brinton, H.G., 2012). Some treatments are also available for nosocomephobia, it is treated with the combination of medicine (Robertson, J.G., 2003). Prescriber prescribes anti-anxiety a medication which helps to decrease the depressive disorders but it is not recommended for long time treatment/use. Some psychotherapy, talk therapy are also recommended. For the facilitations of patients minimize the unnecessary pathological tests which irritate patients which also increase the hospital charges. References Beidel, D.C. and Turner, S.M., Shy children, phobic adults: Nature and treatment of social anxiety disorder (pp ). Washington, DC: American Psychological Association. Brinton, H.G., The Welcoming Congregation: Roots and Fruits of Christian Hospitality. Westminster John Knox Press. Fava, M., Rankin, M.A., Wright, E.C., Alpert, J.E., Nierenberg, A.A., Pava, J. and Rosenbaum, J.F., Anxiety disorders in major depression.comprehensive psychiatry, 41(2), pp Hamilton, M.A.X., The assessment of anxiety states by rating. British journal of medical psychology, 32(1), pp Liebowitz, M.R., Social phobia (pp ). Karger Publishers. Malasi, T.H., Mirza, I.A. and El Islam, M.F., Validation of the hospital anxiety and depression scale in Arab patients. ActaPsychiatricaScandinavica, 84(4), pp Marks, I.M. and Gelder, M.G., Different ages of onset in varieties of phobia. American Journal of Psychiatry, 123(2), pp Pellosmaa, H.B. and Desouky, T.F., Hospital Anxiety. In Encyclopedia of Behavioral Medicine (pp ). Springer New York. Peters, L., Discriminant validity of the social phobia and anxiety inventory (SPAI), the social phobia scale (SPS) and the social interaction anxiety scale (SIAS). Behaviour Research and Therapy, 38(9), pp Robertson, J.G., An excess of phobias and manias. Senior Scribe Publications. Singh, T.K., Ahmad, A. and Chowdhury, A., Differences of thought. Starcevic, V. and Bogojevic, G., Comorbidity of panic disorder with agoraphobia and specific phobia: relationship with the subtypes of specific phobia. Comprehensive psychiatry, 38(6), pp Torgersen, S., Genetic factors in anxiety disorders. Archives of General Psychiatry, 40(10), pp Zigmond, A.S. and Snaith, R.P., The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 67(6), pp Zimmerman, M., McDermut, W. and Mattia, J.I., Frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. American Journal of Psychiatry, 157(8), pp Zehra Ashraf 32